CARDIOVASCULAR EXAMINATION

Measure blood pressure

Palpate
Patient in seated position.
Palpate brachial artery using
finger pads (NOT finger tips or
thumbs).
Center the inflatable bladder of
cuff over the brachial artery
Lower border of cuff should be
about 2.5 cm above
antecubital crease.
Examiner palpates radial
artery with finger pads, and
inflates BP cuff until radial
pulse is no longer felt.
Read the pressure and add
30mm to this number.
Rapidly deflate cuff to zero.
Use this number for
subsequent inflations to
prevent patient discomfort.
Auscultate

Examiner supports patients

arm at the level of the patients
heart.

Place stethoscope (diaphragm

or bell) on brachial artery.

Close valve of pump (dial) by

turning counter clockwise.

Inflate cuff rapidly to level just

determined, then deflate slowly
by turning dial clockwise, 23mm/Hg per second.

Listen carefully the first

sound is the systolic pressure

Lower pressure slowly until the

sound becomes muffled, and
then disappears.
Disappearance point is the
diastolic pressure.

Rapidly deflate cuff to zero.

Examiner must report results in terms of

numbers and if it is normal or not, e.g. Your
blood pressure is 110 over 60, which is
normal, but not simply e.g. your blood
pressure is normal.

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
2

Palpate radial pulse

Palpate for strength and amplitude

Must palpate 15, 30 or 60

seconds.

Palpate with finger pads (NOT

finger tips or thumbs).

Examiner must report results

and interpretation, e.g. Your
pulse is 72, and thats normal.

Cardiovascular inspection

Patient seated.

Gown must be lowered to fully

reveal anterior chest.

Examiner must make it clear he

/ she is inspecting by saying
e.g. Im inspecting your chest
or by noting, e.g. scars, moles,
etc.

Palpate the point of maximal

impulse (PMI)

Patient seated or in left lateral

decubitus position.

Standing to the right of the

patient, palpate the PMI on
skin.

Palpate at the left mid-clavicular

line (5th intercostal space).

Palpate with finger pads (NOT

finger tips or thumbs).

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
5

Auscultate the heart

Standing to the right of the patient,
auscultate the heart on bare skin.

Ask the patient to breathe normally and

auscultate the heart at the aortic,
pulmonic, tricuspid and mitral areas.

Examiner then directs the patient to sit

up and lean forward, and ask patient to
exhale and hold their breath and
auscultate the mitral area.

Ask patient to breathe normally after

auscultation.

Auscultating mitral area

Auscultating pulmonic area

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
6

Auscultate apex, left lateral decubitus

position

Standing to the right of the patient,

auscultate the apex in the left lateral
decubitus position on bare skin with the
bell of the stethoscope.

Apex
7

Inspect for jugular venous pressure (JVP)

Patient seated (NOTE: seated position

acceptable in the ICC setting but correct
position is at 30 degrees when the table
is adjustable).

Turn patients head slightly away from the

side being inspected.

Use tangential lighting and examine both

sides of the neck.

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
8

Palpate carotid arteries

Patient seated or supine.

Standing to the right of the

patient, palpate the carotid
arteries on skin.

Bilateral exam.

Palpate with finger pads, NOT

thumbs or fingertips.

NOTE: Dangerous maneuver

No simultaneous bilateral
palpation, i.e. both sides must
not be palpated at the same
time.

If this is attempted, credit

denied for all cardiovascular
checklists items.

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
9

Auscultate carotid
arteries

Patient seated or supine.

Standing to the right of

the patient, auscultate
the carotid arteries on
skin.

Examiner asks patient to

inhale and hold their
breath.

Auscultate with
stethoscope (bell or
diaphragm).

Ask patient to breathe

normally after
auscultation.

Bilateral exam.

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
10

Palpate dorsalis pedis

pulses

Patient seated or
supine.

Palpate with finger

pads on bare skin,
socks completely off.

Bilateral exam.

Palpate pulses on
dorsum of foot, NOT
ankle.

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)

CARDIOVASCULAR EXAMINATION
11

Check for distal pitting edema

Patient seated or supine

Bilateral exam, on bare skin.

Apply moderate pressure

with thumb for 3-5 seconds
in all of the following areas:
1. Dorsum (top) of feet
socks completely off,
Dorsum (top) feet

2. Ankles - socks
completely off,

Ankles

3. Anterior tibia

Anterior Tibia

2015-16 Academic Year NYIT College of Osteopathic Medicine (Updated 8/13/15)